Long-term survival in older patients given propofol or sevoflurane anaesthesia for major cancer surgery: follow-up of a multicentre randomised trial

Shuang-Jie Cao¹, Yue Zhang², Yu-Xiu Zhang¹, Wei Zhao³, Ling-Hui Pan⁴, Xu-De Sun⁵, Zhen Jia⁶, Wen Ouyang⁷, Qing-Shan Ye⁸, Fang-Xiang Zhang⁹, Yong-Qing Guo¹⁰, Yan-Qiu Ai¹¹, Bin-Jiang Zhao¹², Jian-Bo Yu¹³, Zhi-Heng Liu¹⁴, Ning Yin¹⁵, Xue-Ying Li¹⁶, Jia-Hui Ma¹, Hui-Juan Li¹⁷, Mei-Rong Wang¹⁷, Daniel I Sessler¹⁸, Daqing Ma¹⁹, Dong-Xin Wang²⁰; First Study of Perioperative Organ Protection (SPOP1) investigators

Affiliations

¹ Department of Anesthesiology, Peking University First Hospital, Beijing, China.
² Department of Anesthesiology, Peking University First Hospital, Beijing, China; Clinical Research Institute, Shenzhen Peking University-The Hong Kong University of Science & Technology Medical Center, Shenzhen, China.
³ Department of Anesthesiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
⁴ Department of Anesthesiology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, China.
⁵ Department of Anesthesiology, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, Shaanxi, China.
⁶ Department of Anesthesiology, Affiliated Hospital of Qinghai University, Xining, Qinghai, China.
⁷ Department of Anesthesiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China.
⁸ Department of Anesthesiology, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia Hui Autonomous Region, China.
⁹ Department of Anesthesiology, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China.
¹⁰ Department of Anesthesiology, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China.
¹¹ Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
¹² Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
¹³ Department of Anesthesiology and Critical Care Medicine, Tianjin Nankai Hospital, Tianjin Medical University, Tianjin, China.
¹⁴ Department of Anesthesiology, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen, Guangdong, China.
¹⁵ Department of Anesthesiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, Jiangsu, China; Department of Anesthesiology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.
¹⁶ Department of Biostatistics, Peking University First Hospital, Beijing, China.
¹⁷ Peking University Clinical Research Institute, Peking University Health Science Center, Beijing, China.
¹⁸ Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH, USA; Department of Outcomes Research, Anesthesiology Institute, OH, USA.
¹⁹ Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, UK; National Clinical Research Center for Child Health, Hangzhou, China.
²⁰ Department of Anesthesiology, Peking University First Hospital, Beijing, China; Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH, USA. Electronic address: dxwang65@bjmu.edu.cn.

PMID: 37474242
DOI: 10.1016/j.bja.2023.01.023

Free article

Randomized Controlled Trial

Long-term survival in older patients given propofol or sevoflurane anaesthesia for major cancer surgery: follow-up of a multicentre randomised trial

Shuang-Jie Cao et al. Br J Anaesth. 2023 Aug.

Free article

. 2023 Aug;131(2):266-275.

doi: 10.1016/j.bja.2023.01.023. Epub 2023 Jun 4.

Authors

Affiliations

¹ Department of Anesthesiology, Peking University First Hospital, Beijing, China.
² Department of Anesthesiology, Peking University First Hospital, Beijing, China; Clinical Research Institute, Shenzhen Peking University-The Hong Kong University of Science & Technology Medical Center, Shenzhen, China.
³ Department of Anesthesiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
⁴ Department of Anesthesiology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, China.
⁵ Department of Anesthesiology, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, Shaanxi, China.
⁶ Department of Anesthesiology, Affiliated Hospital of Qinghai University, Xining, Qinghai, China.
⁷ Department of Anesthesiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China.
⁸ Department of Anesthesiology, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia Hui Autonomous Region, China.
⁹ Department of Anesthesiology, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China.
¹⁰ Department of Anesthesiology, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China.
¹¹ Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
¹² Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
¹³ Department of Anesthesiology and Critical Care Medicine, Tianjin Nankai Hospital, Tianjin Medical University, Tianjin, China.
¹⁴ Department of Anesthesiology, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen, Guangdong, China.
¹⁵ Department of Anesthesiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, Jiangsu, China; Department of Anesthesiology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.
¹⁶ Department of Biostatistics, Peking University First Hospital, Beijing, China.
¹⁷ Peking University Clinical Research Institute, Peking University Health Science Center, Beijing, China.
¹⁸ Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH, USA; Department of Outcomes Research, Anesthesiology Institute, OH, USA.
¹⁹ Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, UK; National Clinical Research Center for Child Health, Hangzhou, China.
²⁰ Department of Anesthesiology, Peking University First Hospital, Beijing, China; Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH, USA. Electronic address: dxwang65@bjmu.edu.cn.

PMID: 37474242
DOI: 10.1016/j.bja.2023.01.023

Abstract

Background: Experimental evidence indicates that i.v. anaesthesia might reduce cancer recurrence compared with volatile anaesthesia, but clinical information is observational only. We therefore tested the primary hypothesis that propofol-based anaesthesia improves survival over 3 or more years after potentially curative major cancer surgery.

Methods: This was a long-term follow-up of a multicentre randomised trial in 14 tertiary hospitals in China. We enrolled 1228 patients aged 65-90 yr who were scheduled for major cancer surgery. They were randomised to either propofol-based i.v. anaesthesia or to sevoflurane-based inhalational anaesthesia. The primary endpoint was overall survival after surgery. Secondary endpoints included recurrence-free and event-free survival.

Results: Amongst subjects randomised, 1195 (mean age 72 yr; 773 [65%] male) were included in the modified intention-to-treat analysis. At the end of follow-up (median 43 months), there were 188 deaths amongst 598 patients (31%) assigned to propofol-based anaesthesia compared with 175 deaths amongst 597 patients (29%) assigned to sevoflurane-based anaesthesia; adjusted hazard ratio 1.02; 95% confidence interval (CI): 0.83-1.26; P=0.834. Recurrence-free survival was 223/598 (37%) in patients given propofol anaesthesia vs 206/597 (35%) given sevoflurane anaesthesia; adjusted hazard ratio 1.07; 95% CI: 0.89-1.30; P=0.465. Event-free survival was 294/598 (49%) in patients given propofol anaesthesia vs 274/597 (46%) given sevoflurane anaesthesia; adjusted hazard ratio 1.09; 95% CI 0.93 to 1.29; P=0.298.

Conclusions: Long-term survival after major cancer surgery was similar with i.v. and volatile anaesthesia. Propofol-based iv. anaesthesia should not be used for cancer surgery with the expectation that it will improve overall or cancer-specific survival.

Clinical trial registrations: ChiCTR-IPR-15006209; NCT02660411.

Keywords: aged; cancer surgery; inhalation anaesthesia; intravenous anaesthesia; morbidity; propofol; sevoflurane; survival.

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Long-term survival in older patients given propofol or sevoflurane anaesthesia for major cancer surgery: follow-up of a multicentre randomised trial

Affiliations

Long-term survival in older patients given propofol or sevoflurane anaesthesia for major cancer surgery: follow-up of a multicentre randomised trial

Authors

Affiliations

Abstract

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Medical